If potential benefit outweighs risk of serious arrhythmia, monitor for arrhythmia with ECG prior to administration and for 2–3 hours after completion of therapy.114

Contraindicated in patients with known or suspected QT prolongation, including congenital long QT syndrome.114

Use with extreme caution in patients at risk for prolonged QT syndrome (e.g., CHF, bradycardia, diuretic use, cardiac hypertrophy, hypokalemia, hypomagnesemia, use of other drugs known to prolong QT interval).114 Other risk factors may include age >65 years, alcohol abuse, and concomitant use of benzodiazepines, volatile anesthetics, or IV opiates.114 (See Prolonged QT Syndrome under Cautions.)

Initiate droperidol at low dose and increase with caution as needed to achieve desired effect.114

Introduction

Butyrophenone derivative; structurally similar to haloperidol; pharmacologically similar to haloperidol and phenothiazines.a

Uses for Droperidol

Nausea and Vomiting Associated with Surgical and Diagnostic Procedures

Reduction of the incidence of nausea and vomiting associated with surgical and diagnostic procedures.114a Because of the risk of serious, sometimes fatal proarrhythmic effects, use only in patients who fail to respond adequately (because of insufficient efficacy or intolerable adverse effects) to other antiemetic therapy.114 (See Boxed Warning.)

Adjunct to Anesthesia and Neuroleptanalgesia

Has been used preoperatively† and as an adjunct during induction and maintenance of general anesthesia† and as an adjunct to regional anesthesia†; also has been used in combination with an opiate analgesic (e.g., fentanyl) for neuroleptanalgesia† as an anxiolytic and to potentially increase the opiate analgesic effect.a No longer recommended for these uses because of the risk of serious adverse effects.112113

Nausea and Vomiting Associated with Cancer Chemotherapy

Has been used effectively alone or in combination antiemetic regimens to prevent and/or reduce cancer chemotherapy-induced nausea and vomiting†, principally that induced by cisplatin.100101102103104105106107

Delirium

Occasionally used in the management of delirium†;108 has been effective in the management of agitation (not necessarily delirium) and may be preferred to haloperidol in some delirious patients due to shorter half-life, more rapid onset of effect, and increased sedative effects.108109110111

Droperidol Dosage and Administration

General

Routinely monitor vital signs and ECG.114

Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer IM or by slow IV injection.114a

Dosage

Individualize dosage according to the patient’s age, weight, physical status, and underlying pathologic condition.114 Also consider other drugs, type of anesthesia used, and surgical procedure.114

Pediatric Patients

Nausea and Vomiting Associated with Surgical and Diagnostic Procedures

IV or IM

Children 2–12 years of age: Initially, up to 0.1 mg/kg (maximum of 2.5 mg), based on the patient’s age and clinical condition.114116 Administer additional doses with caution and only if potential benefit outweighs potential risk.114

Adults

Nausea and Vomiting Associated with Surgical and Diagnostic Procedures

IV or IM

Initially, up to 2.5 mg.114 Administer additional doses of 1.25 mg with caution to achieve the desired effect, if potential benefit outweighs the potential risk.114

Warnings/Precautions

Warnings

Prolonged QT Syndrome

ECG monitoring is recommended; do not use if QT interval prolongation is present.114

Use with extreme caution in patients with risk factors for prolonged QT syndrome, including clinically important bradycardia (<50 bpm) or heart disease (e.g., CHF , cardiac hypertrophy); treatment with class I or III antiarrhythmic agents, MAO inhibitors, or other drugs known to prolong the QT interval; electrolyte imbalance (particularly hypomagnesemia or hypokalemia); or treatment with drugs (e.g., diuretics) that may cause electrolyte imbalance.114

Consider repositioning patient to improve venous return to the heart when operative conditions permit; however, during spinal and peridural anesthesia, placing the patient into a head-down position may result in a higher level of anesthesia than is desirable and may impair venous return to the heart.114 Because of the possibility of orthostatic hypotension, use care when moving and positioning patients during anesthesia.114

If hypotension is not corrected with fluids or repositioning, consider use of pressor agents, but not epinephrine (may paradoxically decrease BP due to droperidol’s α-adrenergic blockade).114

CNS Depression

CNS depressant effects; monitor vital signs routinely.114

Concurrent Use With Opiate Agonists

When concurrent use of opiates and droperidol is required, administer opiates in reduced dosage.114 Be familiar with each drug, particularly widely differing durations of action.a

Respiratory depression induced by opiates persists longer than analgesic effects.a Before ordering opiate analgesics during anesthesia recovery, consider total dosage of administered opiates; if opiates are required during the recovery period, use initially in reduced dosages (as low as one-fourth to one-third of those usually recommended).a Keep resuscitative equipment and an opiate antagonist readily available to manage apnea.a

Reduce initial droperidol dose in patients who have received other CNS depressants, or vice versa114

Cyclobenzaprine

Torsades de pointes, with progression to ventricular fibrillation, reported with concomitant use of droperidol, cyclobenzaprine, and fluoxetine.115 (Possible mechanism: inhibition of cyclobenzaprine metabolism by fluoxetine; droperidol may have contributed to QT interval prolongation and development of torsades de pointes.115 )

Diuretics

Potential for diuretic-induced hypokalemia or hypomagnesemia resulting in prolongation of the QT interval114

Use with caution114

Epinephrine

Possible paradoxical decrease in BP due to droperidol’s α-adrenergic blockade114

Use pressor agents other than epinephrine to treat hypotension that is unresponsive to IV fluids or repositioning of the patient114

Fentanyl

Increased BP reported (with or without preexisting hypertension) when droperidol administered with fentanyl or other parenteral analgesics (increased BP possibly resulted from unexplained changes in sympathetic activity after large doses or due to anesthetic/surgical stimulation during light anesthesia)114

Laxatives

Potential for laxative-induced hypokalemia or hypomagnesemia resulting in prolongation of the QT interval114